Surgical Resection of Jugular Foramen Schwannoma to preserve Neural Function

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  • 頚静脈孔神経鞘腫における神経機能温存を目指した手術

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<p>  Jugular foramen schwannoma is a relatively rare form of schwannoma and accounts for 2.9% of all intracranial schwannomas. Most of the jugular foramen schwannomas form dumbbell-shaped tumors that extend from the intracranial lesion toward the extracranial location to different degrees. Because these tumors grow slowly, a surgical indication should be determined by considering multiple factors such as the patient’s age, performance status, symptoms, and the volume of the tumor. In this paper, microsurgical anatomy around the jugular foramen, the surgical approach, and the outcome were discussed.</p><p>  The glossopharyngeal nerve, the vagus nerve, and the accessory nerve run in the lateral medullary cistern toward the jugular foramen and turn at the foramen just medial to the jugular bulb. After exiting from the foramen, these nerves run toward the caudal direction in front of the axis.</p><p>  A transjugular approach is mandatory to perform resection of intra- and extradural tumors. In addition, high cervical exposure is required when the tumor is extending toward the ventral location of the cervical spine. For the intradural part of the tumor, total resection is performed to release the compression of the brain stem and the nerves in the lateral medulla. For the extradural part, an intracapsular removal is considered for preserving the function of the lower cranial nerves.</p><p>  Analysis of the postoperative symptoms demonstrated that the function of the nerve which was the origin of the schwannoma was not preserved. However, the neurological impairments that were caused by the compression by the tumor tended to recover after the surgery.</p><p>  In conclusion, meticulous surgical resection of jugular foramen schwannoma based on the precise microsurgical anatomy may result in the functional recovery of the compressed neural structures.</p>

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